{"title":"脑桥角手术的半坐位：并发症分析及如何避免并发症","authors":"Pelayo Hevia Rodríguez , Alejandro Elúa Pinín , Amaia Larrea Aseguinolaza , Nicolás Samprón , Mikel Armendariz Guezala , Enrique Úrculo Bareño","doi":"10.1016/j.neucie.2023.07.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the primary complications related to semisitting position in patients undergoing cerebelo-pontine angle surgery.</p></div><div><h3>Methods</h3><p><span>Retrospective data analysis from patients undergoing elective tumoral cerebelo-pontine angle surgery in a semisitting position. The incidence, severity, occurrence moment, treatment, duration, and outcomes of venous air embolism (VAE), </span>pneumocephalus<span>, postural hypotension<span>, and other complications were recorded. Neurointensive care unit (NICU), length of stay (LOS), hospital LOS, and modified Rankin scale scores were calculated six months after surgery.</span></span></p></div><div><h3>Results</h3><p>Fifty patients were operated on. Eleven (22%) presented VAE (mean duration 8<!--> <!-->±<!--> <!-->4.5<!--> <span>min): five (10%) during tumor resection, and four (8%) during dural opening. Ten (20%) were resolved by covering the surgical bed, air bubbles aspiration, jugular compression, and one (2%) tilted to a steep Trendelenburg position<span>. One (2%) had intraoperative hemodynamic<span> instability. The only variable associated with VAE was meningioma at histopathology OR</span></span></span> <!-->=<!--> <!-->4.58, <em>p</em> <!-->=<!--> <!-->0.001. NICU was higher in patients with VAE (5.5<!--> <!-->±<!--> <!-->1.06 vs. 1.9<!--> <!-->±<!--> <!-->0.20 days, <em>p</em> <!-->=<!--> <span>0.01). There were no differences in the Rankin scale. All patients presented postoperative pneumocephalus with a good level of consciousness, except one (2%) who required evacuation<span>. Seven patients (14%) showed postural hypotension, three (6%) after positioning, and one (2%) after developing a VAE; all were reversed with usual vasoactive drugs. No other position-related complications or mortality were registered in this series.</span></span></p></div><div><h3>Conclusions</h3><p>The semisitting position is a safe option with the knowledge, prevention, detection, and early solution of all the possible complications. The development of VAE rarely implies hemodynamic instability or greater disability after surgery. Postoperative pneumocephalus is very common and rarely requires evacuation. Excellent cooperation between anesthesia, nursing, neurophysiology, and neurosurgery teams is essential to manage complications.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 1","pages":"Pages 18-29"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Semisitting position for cerebello-pontine angle surgery: Analysis of complications and how to avoid it\",\"authors\":\"Pelayo Hevia Rodríguez , Alejandro Elúa Pinín , Amaia Larrea Aseguinolaza , Nicolás Samprón , Mikel Armendariz Guezala , Enrique Úrculo Bareño\",\"doi\":\"10.1016/j.neucie.2023.07.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To analyze the primary complications related to semisitting position in patients undergoing cerebelo-pontine angle surgery.</p></div><div><h3>Methods</h3><p><span>Retrospective data analysis from patients undergoing elective tumoral cerebelo-pontine angle surgery in a semisitting position. The incidence, severity, occurrence moment, treatment, duration, and outcomes of venous air embolism (VAE), </span>pneumocephalus<span>, postural hypotension<span>, and other complications were recorded. Neurointensive care unit (NICU), length of stay (LOS), hospital LOS, and modified Rankin scale scores were calculated six months after surgery.</span></span></p></div><div><h3>Results</h3><p>Fifty patients were operated on. Eleven (22%) presented VAE (mean duration 8<!--> <!-->±<!--> <!-->4.5<!--> <span>min): five (10%) during tumor resection, and four (8%) during dural opening. Ten (20%) were resolved by covering the surgical bed, air bubbles aspiration, jugular compression, and one (2%) tilted to a steep Trendelenburg position<span>. One (2%) had intraoperative hemodynamic<span> instability. The only variable associated with VAE was meningioma at histopathology OR</span></span></span> <!-->=<!--> <!-->4.58, <em>p</em> <!-->=<!--> <!-->0.001. NICU was higher in patients with VAE (5.5<!--> <!-->±<!--> <!-->1.06 vs. 1.9<!--> <!-->±<!--> <!-->0.20 days, <em>p</em> <!-->=<!--> <span>0.01). There were no differences in the Rankin scale. All patients presented postoperative pneumocephalus with a good level of consciousness, except one (2%) who required evacuation<span>. Seven patients (14%) showed postural hypotension, three (6%) after positioning, and one (2%) after developing a VAE; all were reversed with usual vasoactive drugs. No other position-related complications or mortality were registered in this series.</span></span></p></div><div><h3>Conclusions</h3><p>The semisitting position is a safe option with the knowledge, prevention, detection, and early solution of all the possible complications. The development of VAE rarely implies hemodynamic instability or greater disability after surgery. Postoperative pneumocephalus is very common and rarely requires evacuation. Excellent cooperation between anesthesia, nursing, neurophysiology, and neurosurgery teams is essential to manage complications.</p></div>\",\"PeriodicalId\":74273,\"journal\":{\"name\":\"Neurocirugia (English Edition)\",\"volume\":\"35 1\",\"pages\":\"Pages 18-29\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurocirugia (English Edition)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2529849623000242\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocirugia (English Edition)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2529849623000242","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：分析脑白质角手术患者半坐卧位的主要并发症：分析半坐卧位脑桥角手术患者的主要并发症：方法：对以半坐位接受择期肿瘤脑桥角手术的患者进行回顾性数据分析。记录了静脉空气栓塞（VAE）、气胸、体位性低血压和其他并发症的发生率、严重程度、发生时间、治疗方法、持续时间和结果。计算手术后六个月的神经重症监护室（NICU）、住院时间（LOS）、住院时间和改良Rankin量表评分：结果：50 名患者接受了手术。11例（22%）出现VAE（平均持续时间为8±4.5分钟）：5例（10%）在肿瘤切除过程中出现，4例（8%）在硬脑膜开放过程中出现。10例（20%）通过覆盖手术床、抽吸气泡、压迫颈静脉和1例（2%）倾斜至陡峭的 Trendelenburg 体位而缓解。一人（2%）术中血流动力学不稳定。与VAE相关的唯一变量是组织病理学检查发现的脑膜瘤，OR=4.58，P=0.001。VAE患者的新生儿重症监护时间较长（5.5±1.06 天 vs. 1.9±0.20天，P=0.01）。兰金量表没有差异。除一名患者（2%）需要排空外，所有患者术后均出现意识清醒的气胸。七名患者（14%）出现体位性低血压，其中三人（6%）是在体位调整后出现的，一人（2%）是在出现 VAE 后出现的；所有患者都在使用常规血管活性药物后得到了逆转。本系列病例中未发现其他与体位相关的并发症或死亡病例：半坐卧位是一种安全的体位选择，可以预防、检测和及早解决所有可能出现的并发症。VAE的发生很少意味着血流动力学的不稳定或术后更大的残疾。术后气胸很常见，但很少需要排气。麻醉、护理、神经生理学和神经外科团队之间的良好合作对于处理并发症至关重要。
Semisitting position for cerebello-pontine angle surgery: Analysis of complications and how to avoid it
Objective
To analyze the primary complications related to semisitting position in patients undergoing cerebelo-pontine angle surgery.
Methods
Retrospective data analysis from patients undergoing elective tumoral cerebelo-pontine angle surgery in a semisitting position. The incidence, severity, occurrence moment, treatment, duration, and outcomes of venous air embolism (VAE), pneumocephalus, postural hypotension, and other complications were recorded. Neurointensive care unit (NICU), length of stay (LOS), hospital LOS, and modified Rankin scale scores were calculated six months after surgery.
Results
Fifty patients were operated on. Eleven (22%) presented VAE (mean duration 8 ± 4.5 min): five (10%) during tumor resection, and four (8%) during dural opening. Ten (20%) were resolved by covering the surgical bed, air bubbles aspiration, jugular compression, and one (2%) tilted to a steep Trendelenburg position. One (2%) had intraoperative hemodynamic instability. The only variable associated with VAE was meningioma at histopathology OR = 4.58, p = 0.001. NICU was higher in patients with VAE (5.5 ± 1.06 vs. 1.9 ± 0.20 days, p = 0.01). There were no differences in the Rankin scale. All patients presented postoperative pneumocephalus with a good level of consciousness, except one (2%) who required evacuation. Seven patients (14%) showed postural hypotension, three (6%) after positioning, and one (2%) after developing a VAE; all were reversed with usual vasoactive drugs. No other position-related complications or mortality were registered in this series.
Conclusions
The semisitting position is a safe option with the knowledge, prevention, detection, and early solution of all the possible complications. The development of VAE rarely implies hemodynamic instability or greater disability after surgery. Postoperative pneumocephalus is very common and rarely requires evacuation. Excellent cooperation between anesthesia, nursing, neurophysiology, and neurosurgery teams is essential to manage complications.
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